Depersonalization disorder

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at July 21, 2016
StartDiseasesDepersonalization disorder

Depersonalization disorder (DPD), sometimes known as depersonalization-derealization disorder, is believed to affect up to 2% of adults and manifests as a sense of utter detachment and an absence of emotions. It affects women more than men.

Contents

Definition & Facts

Depersonalization disorder is a type of dissociative disorder, which is a mental disorder that involves the breakdown of awareness, identity, memory, and/or perception. People with DPD experience a feeling of being detached from their body, emotions, and thoughts (depersonalization) and/or detached from their environment (derealization).

Unlike some dissociative disorders, people with DPD are aware that their perception is not real. Temporary or transient depersonalization is very common and estimated to occur in about half of all people, but DPD is believed to occur in about 2% of people, making it more common than schizophrenia

Symptoms & Complaints

The symptoms of depersonalization disorder are classified as derealization or depersonalization. Depersonalization is a disconnection from the person's emotions, thoughts, and/or body. Many people with DPD describe it as feeling as though they are an outside party observing their body or thoughts. This may present as an out-of-body experience or an inability to feel their reflections are their own.

Derealization is the sense of detachment from the person's surroundings, sometimes as if living in a film. Some people with the disorder report that their environment is visually distorted or has a surreal quality. Derealization may present as a distortion in time perception, such as feeling outside of time or feeling as though recent events were in the distant past.

DPD commonly causes an absence of emotion - either positive or negative. Some report that their memories seem to lack emotion and that they do not feel as if they are their own. Along with these symptoms of DPD, many people experience depression, anxiety, panic attacks, and phobias as a result of the condition. The disorder may also lead to physical symptoms in some people such as blurred vision, nausea, chest pain, and a pins and needles sensation. 

Causes

Very little is known about depersonalization-derealization disorder, although it does tend to occur in younger people. The average age of onset of DBD is 16. It's believed that environmental factors and genetic factors influence the development of the disorder, and some people seem more susceptible to developing dissociative disorders. This may be due to the presence of a personality disorder or the chemistry in one's brain (neurochemistry).

Many dissociative disorders, including depersonalization disorder, seem to be triggered by intense or traumatic events, including accidents, natural disaster, war, torture, violence, childhood abuse, or a bad experience with drugs. The most common precipitators to the disorder are major depressive disorder, intense psychological stress, and the use of hallucinogens.

Research has also shown that cannabis use can lead to depersonalization symptoms. Research in neurobiology has identified some functional brain abnormalities that may be linked to DBD. One PET scan found abnormalities in the auditory cortex, visual cortex, and somatosensory cortex.

Diagnosis & Tests

Depersonalization disorder is thought to be underdiagnosed with many patients reportedly spending years visiting primary physicians and psychiatrists before a diagnosis, in part because the disorder is often unfamiliar to medical professionals as well as laymen. No lab tests can diagnose depersonalization disorder and there is not always an obvious trigger. Instead, a diagnosis is based on a person's self-reported symptoms and experiences followed by a clinical assessment.

A psychiatric assessment generally includes a psychiatric or medical history along with a mental status examination (MSE) which involves observing and describing a patient's thought process, speech, mood, behavior, state of mind, cognition, perception, judgment, and insight. A psychiatrist will also rule out other disorders that may mimic DPD symptoms such as acute stress disorder, a brain tumor, drug use, and schizophrenia.

The Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D) is the most widely used test for DPD and it takes anywhere from 30 to 90 minutes. The diagnostic criteria for depersonalization disorder according to the Diagnostic and Statistical Manual of Mental Disorders (DSM) are: 

  • Recurring or longstanding sense of detachment from one's body or mental processes
  • Reality testing shows the patient has an ability to distinguish between the internal world of thoughts and feelings and the outside world of external reality; in other words, they recognize their depersonalization episodes as unusual.
  • The disorder causes significant distress or difficulty in daily life
  • The symptoms do not occur only when the person is experiencing a different mental disorder and is not associated with an illness or substance use.

Treatment & Therapy

Patients with DPD typically seek treatment for symptoms caused by the disorder, such as anxiety and depression, rather than the disorder itself. Nonetheless, there are several treatment approaches to DPD which are dependent upon the severity of the symptoms.

Psychotherapy or talk therapy is usually the first course of treatment recommended for DPD to help the patient recognize and communicate their feelings about conflicts that may lead to depersonalization. Family therapy, art therapy, and music therapy may also be recommended. Depending on the suspected cause of the disorder, eye movement desensitization and reprocessing (EMDR) may be used. This treatment was designed to treat flashbacks and symptoms of posttraumatic stress disorder (PTSD), which may be a trigger of DPD.

Psychiatric medications may be prescribed to treat anxiety and depression that may accompany DPD. Many factors have been found to usually diminish the symptoms of DPD. These include practicing relaxation techniques and creating and nurturing personal relationships. A healthy diet and regular exercise may reduce the severity of symptoms while fatigue and alcohol tend to worsen symptoms. 

Prevention & Prophylaxis

Preventing depersonalization disorder may not be possible as the disorder can be triggered by severe life events outside of a person's control. Treatment may be more successful if it begins as soon as the patient notices symptoms. Swift intervention after a traumatic event may reduce the risk of developing DPD or other dissociative disorders.